Tag Archives: Ontario Health System

Hospital funding freeze, high admin costs show up in quality indicators

For all the shortfalls in Ontario’s health system, the reality is that despite having among the lowest per capita levels of funding, the province is matching if not excelling the Canadian average in many categories measured by the Canadian Institute for Health Information (CIHI).

Whether this reflects well on Ontario or badly on the rest of the Canada is an open debate.

CIHI is widely respected as being an unbiased source of information for health planners although they remain at the mercy of local health providers who provide the inputs.

Mortality rates, for example, have been known to fluctuate widely once a hospital has learned to game the system. Only unexpected deaths count, so most deaths become expected.

CIHI has established a site where you can compare provinces on 37 indicators. Just enter your province and determine whether you want the summary or the detailed report. (Click here to access the site)

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PC Platform: Tim Hudak wants you to compete for the job you have

Tim Hudak is no longer the mystery man. The question is, now that his Ontario Progressive Conservative (PC) platform is out there, will it matter?

Hudak has made it clear that he intends to make public sector workers a target, including workers in health care.

“We will introduce initiatives requiring public sector unions to compete for government contracts, where appropriate,” the Tory Changebook states. “If another organization – whether a non-profit group or private business – can provide better value for money, taxpayers deserve to benefit.”

The platform goes on to suggest support services “like food preparation or laundry” in our “public institutions” are a prime example where he expects these competitions to take place.

If you are spared the competition, you may not have your next contract fairly arbitrated. Hudak plans to challenge the independence of the arbitrators, claiming recent awards have been “excessive.”

“We will require arbitrators to respect the ability of taxpayers to pay and take into account local circumstances,” the document states.

Changebook claims the Tories will “bring public sector paycheques in line with private sector standards.”

Specific to health care, Changebook makes the same promise as the McGuinty Liberals when it comes to funding – reduce increases to three per cent per year.

Hudak promises a review of all agencies and commissions, but would axe the LHINs before that even takes place. He would not replace the LHINs, which raises questions about how health care planning, local funding, and community engagement will take place. He says he will redirect the $70 million per year from closing the LHINs into front line care. At present Ontario spends $47 billion on public health care.

The Tories say they will add 5,000 new long term care beds and increase investments in home care to “give families more control over services.” That includes the ability to stay with the provider they have now, or pick a new government-funded home care provider who better meets their individual needs. Given the Tories have supported competitive bidding in home care, it is unclear whether an individual will be able to maintain their provider after they have lost the CCAC contract. While the Tories promise to increase investments in home care, they also promise to find savings at the CCACs.

Hudak says he will clamp down on fraud, but the only specific promise is to demand that people using the old red and white health cards also present another form of government-issued identification, such as a driver’s license or passport.

Unlike the Federal NDP, which promised more doctors and nurses, the Tories only claim to add to the number of doctors by increasing residency placements for medical students from Ontario who have pursued their education outside Canada. They call upon doctors, nurses, nurse practitioners, and physician assistants to work collaboratively, particularly in underserviced areas. There is no mention of the other health professions integral to the public health system.

Like the McGuinty Liberals, the Tories vow to be as obsessive about measuring health outcomes and “introducing a rigorous system of patient satisfaction.” Do we read that as even more patient satisfaction forms to fill out? And how does this square with the promise to reduce bureaucracy?

The Tories say they will make it law that the province cannot raise taxes without a clear mandate. Unfortunately, it is silent on needing the same to cut taxes, particularly for corporations.

They also promise to expand the scope of Freedom of Information, but it is not clear how.

The Tories have already come under fire for their spending commitments and tax cuts. The normally conservative Ottawa Citizen called it the “common nonsense revolution,” comparing Hudak’s plans to reckless debt run up by U.S. President George Bush. “Unlike Bush,” writes Citizen editorial board member Ken Gray, “Premier Dalton McGuinty has required Ontarians to pay for the services they receive for which his government has been dubbed ‘tax and spend’ by people who would rather spend, borrow and pay interest.”

“Hudak’s election platform is the kind of document that made Greece the model of fiscal prudence it is today,” writes Gray.

Ontario looks at hospital report cards — Citizen

How many stars does your hospital have? According to the Ottawa Citizen, the Ontario government is contemplating a public ranking system for hospitals.

Ironically, as government MPPs bought the OHA argument that access to quality information from hospital committees would amount to naming and shaming, the ranking system appears to do just that.

The system was tried briefly in the United Kingdom, but ran into numerous problems. The naming and blaming turned back on government as hospitals with low ratings complained of lack of funding. Low rated hospitals also tried to spend their way out of the low ratings, resulting in escalating deficits.

The Citizen reports considerable gaming of data took place in the UK, including making patients linger outside hospitals in ambulances to meet the target of a four hour wait for treatment.

In 2005 the UK government ended the star system in favour of a two-part report card on quality and resource utilization. Hospitals were given a rating on a continuum from excellent to weak.

Some claim that shining the light on hospital performance spurs them on to improvement.

At present Ontario hospitals are posting performance information on their web sites as part of the Excellent Care For All Act. However, this information is not always easy to find. For the average Ontarians, it may also be difficult to decipher what the score card actually means.

In the case of emergency department wait times, hospital funding is connected to performance, as is CEO remuneration.

By attaching hospital funding to the report card it does pose the risk of penalizing not just the hospital, but the community accessing that hospital. Given few communities have any opportunity to elect members of their hospital board, it seems incumbent on government to fix poor performing hospitals rather than create a gap in quality access between communities. We can probably guess which well-heeled communities would have high-performing hospitals, and which would lose funding under such a scenario.

A quality agenda is always welcome, but it should focus on improving the whole system, not on creating winners and losers.